How dangerous is it for people with bipolar disorder to use alcohol?
New research suggests that it may not be as risky as previously thought.
Dr. Jan van Zaane of the University Medical Centre Amsterdam in the Netherlands and his colleagues studied a group of older, stable, medically compliant bipolar patients and noted, “our findings suggest that recommendations to patients with bipolar disorder to refrain from alcohol completely are not applicable to all patients with bipolar disorder.”
Substance use and abuse is a serious problem, and is frequently associated with psychiatric illness. Nearly half of schizophrenic patients , for example, have concurrent drug or alcohol abuse with serious consequence, often resulting from decreased compliance with treatment, such as a higher risk of suicide, violence, worsening of symptoms, and decreased overall functioning. More than 60 percent of bipolar individuals, according to some data, have substance abuse problems.
Van Zaane and his team followed 137 outpatients with either bipolar I or II disorder to ascertain what impact alcohol use had upon their overall functioning, and upon their symptoms and control of the illness. 66 percent of participants were diagnosed with bipolar I, and 34 percent with bipolar II; all were between the ages of 23 and 68. The individuals were followed for up to 52 weeks.
Each participant rated their mood and alcohol intake daily. For purposes of statistical analysis they were divided into three groups, no alcohol use, moderate alcohol use, and excessive alcohol use.
Patients used the National Institute of Mental Health Self-Rating Prospective Life-Chart Method (LCM) on a daily basis, and Van Zaane’s team also assessed patients each month using the Clinical Global Impressions Scale-Bipolar Version, the Global Assessment of Functioning scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey.
At baseline, the research team found no significant differences between the three groups with regard to socioeconomic or clinical status. After a year of followup, they still saw no statistical difference between any of the groups with regard to bipolar disorder, including number of days affected by manic or hypomanic symptoms, depression, severity of depression, overall bipolar illness as measured by the four scales listed above, or in the number of episodes.
The results of this study further complicate the already murky relationship between bipolar illness and substance use. While there is a wide body of well-documented, well-designed research that clearly shows a strong association between alcohol use and bipolar illness, the nature of that relationship is less clear. Do bipolar patients use alcohol to self-medicate? Or is there some characteristic of the illness that drives substance abuse? Or does substance use increase the risk of bipolar illness? Are the poor outcomes often seen with substance use attributable to noncompliance with treatment or with impulsivity associated with intoxication?
Furthermore, other studies have clearly documented an increased risk of suicide, violence, and other negative consquences associated with substance abuse. Of note in this study, the patients were on average older, with an average duration of illness of 22 years, and the vast majority (90 percent) were compliant with their bipolar treatment regimen. Perhaps medication adherance is the most critical element.
Certainly, alcohol is contraindicated with many medications used in the treatment of bipolar illness, and one should discuss any such lifestyle changes with one’s physician, as some medication and alcohol interactions may have severe consequence. Each bipolar patient’s treatment plan must be carefully individualized between patient and clinician.
However, per Van Zaane, “Our findings suggest that recommendations to patients with bipolar disorder to refrain from alcohol completely (may) not be applicable to all patients with bipolar disorder.”
“Nevertheless, we support recommendations from others that patients with a comorbid (alcohol use) disorder should receive integrated treatment…especially to bipolar disorder patients in the early course of their illness.”
Van Zaane’s results can be found in the July issue of the Journal of Clinical Psychiatry.
Source: Journal of Clinical Psychiatry